Pneumonia

What is pneumonia?

Pneumonia is a lung infection that can make you very sick. You may cough, run a fever, and have a hard time breathing. For most people, pneumonia can be treated at home. It often clears up in 2 to 3 weeks. But older adults, babies, and people with other diseases can become very ill. They may need to be in the hospital.

You can get pneumonia in your daily life, such as at school or work. This is called community-based pneumonia. You can also get it when you are in a hospital or nursing home. This is called hospital-based pneumonia. It may be more severe because you already are ill. This topic focuses on pneumonia you get in your daily life.

What causes pneumonia?

Germs called bacteria or viruses usually cause pneumonia.

Pneumonia usually starts when you breathe the germs into your lungs. You may be more likely to get the disease after having a cold or the flu. These illnesses make it hard for your lungs to fight infection, so it is easier to get pneumonia. Having a long-term, or chronic, disease like asthma, heart disease, cancer, or diabetes also makes you more likely to get pneumonia.

What are the symptoms?

Symptoms of pneumonia caused by bacteria usually come on quickly. They may include:

• Cough. You will likely cough up mucus (sputum) from your lungs. Mucus may be rusty or green or tinged with blood.
• Fever.
• Fast breathing and feeling short of breath.
• Shaking and "teeth-chattering" chills. You may have this only one time or many times.
• Chest pain that often feels worse when you cough or breathe in.
• Fast heartbeat.
• Feeling very tired or feeling very weak.

When you have mild symptoms, your doctor may call this "walking pneumonia."

Older adults may have different, fewer, or milder symptoms. They may not have a fever. Or they may have a cough but not bring up mucus. The main sign of pneumonia in older adults may be a change in how well they think. Confusion or delirium is common. Or, if they already have a lung disease, that disease may get worse.

Symptoms caused by viruses are the same as those caused by bacteria. But they may come on slowly and often are not as obvious or as bad.

How is pneumonia diagnosed?

Your doctor will ask you about your symptoms and do a physical exam. He or she may order a chest X-ray and a blood test. This is usually enough for your doctor to know if you have pneumonia. You may need more tests if you have bad symptoms, are an older adult, or have other health problems. In general, the sicker you are, the more tests you will have.

Your doctor may also test mucus from your lungs to find out what germ is causing your pneumonia. Finding the exact germ can help your doctor choose the best medicine for you.

How is it treated?

Your doctor will give you medicines called antibiotics. These almost always cure pneumonia. You need to take all of your antibiotics so you get well. Do not stop taking them because you feel better. Take them exactly as your doctor tells you.

Pneumonia can make you feel very sick. But after you take antibiotics, you should start to feel much better. Call your doctor if you do not start to feel better after 2 full days of antibiotics. Call your doctor right away if you feel worse.

There are things you can do to feel better during your treatment. Get plenty of rest and sleep, and drink lots of liquids. Do not smoke. If your cough keeps you awake at night, talk to your doctor about using cough medicine.

You may need to go to the hospital if you have bad symptoms, a weak immune system, or another serious illness.

Pneumonia caused by a virus usually cannot be treated with antibiotics. Home treatment, such as rest and taking care of your cough, is the only treatment.

How can I prevent pneumonia?

If you are older than 65 or you have a heart or lung problem, you may want to get a pneumonia vaccine. This shot may prevent pneumonia. Since flu can lead to pneumonia, a flu shot may also be a good idea.

You can also lower your chances of getting pneumonia by staying away from people who have the flu, colds, measles, or chickenpox. You may get pneumonia after you have one of these illnesses.

Frequently Asked Questions

Viruses, bacteria, or (in rare cases) parasites or other organisms cause pneumonia.

• In most cases, the specific organism (such as bacteria or virus) cannot be identified even with testing.¹ When an organism is identified, it is usually the bacteria Streptococcus pneumoniae.²
• Other bacteria that may cause pneumonia include Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila (the bacteria that cause Legionnaires' disease), Staphylococcus aureus, Moraxella catarrhalis, Streptococcus pyogenes, Neisseria meningitidis, or Klebsiella pneumoniae. Pneumonia caused by Mycoplasma pneumoniae is sometimes mild and called walking pneumonia.
• Viruses, such as influenza A (the flu virus) and respiratory syncytial virus (RSV) can cause pneumonia.

In people with impaired immune systems, pneumonia may be caused by other organisms, including some forms of fungi, such as Pneumocystis jiroveci (formally called Pneumocystis carinii). This fungus frequently causes pneumonia in people who have AIDS. Some doctors may suggest an HIV test if they think that Pneumocystis jiroveci is causing the pneumonia.

Transmission

You may get pneumonia:

• After you breathe infected air particles into your lungs.
• After you breathe certain bacteria from your nose and throat into your lungs. This generally occurs during sleep.
• During or after a viral upper respiratory infection, such as a cold or influenza (flu).
• As a complication of a viral illness, such as measles or chickenpox.
• If you breathe large amounts of food, gastric juices from the stomach, or vomit into the lungs (aspiration pneumonia). This can happen when you have had a medical condition that affects your ability to swallow, such as a seizure or stroke.

A healthy person's nose and throat often contain bacteria or viruses that cause pneumonia. Pneumonia can develop when these organisms spread to your lungs while your lungs are more likely to be infected, such as during or soon after a cold or if you have a long-term (chronic) illness, such as chronic obstructive pulmonary disease.

You can get pneumonia in your daily life, such as at school or work (community-based pneumonia) or when you are in a hospital or nursing home (hospital-based pneumonia). Treatment may differ in hospital-based pneumonia because bacteria causing the infection in hospitals may be different from those causing it in the community. This topic focuses on community-based pneumonia.

Symptoms of pneumonia caused by bacteria in otherwise healthy people younger than 65 usually come on suddenly. They often start during or after an upper respiratory infection, such as influenza or a cold, and may include:

• Cough, often producing mucus (sputum) from the lungs. Mucus may be rusty or green or tinged with blood.
• Fever, which may be less common in older adults.
• Shaking, "teeth-chattering" chills (one time only or many times).
• Fast, often shallow, breathing and the feeling of being short of breath.
• Chest wall pain that is often made worse by coughing or breathing in.
• Fast heartbeat.
• Feeling very tired (fatigue) or feeling very weak (malaise).

Symptoms of pneumonia not caused by bacteria (nonbacterial) include fever, cough, shortness of breath, and little mucus when you cough. They may come on gradually and are often less obvious and less severe than those of bacterial pneumonia. Many people don't know that they have nonbacterial pneumonia because they do not feel sick.

When symptoms are mild, your doctor may call your condition "walking pneumonia."

Older adults and children

Older adults may have different, fewer, or milder symptoms, such as no fever or a cough with no mucus (a dry or nonproductive cough). The major sign of pneumonia in older adults may be a change in how clearly they think (confusion or delirium) or a worsening of a lung disease they already have.

In children, symptoms may depend on age:

• In infants younger than 1 month of age, symptoms may include having little or no energy (lethargy), feeding poorly, grunting, or having a fever.
• In children, symptoms of pneumonia are often the same as in adults. Your doctor will look for signs such as cough and a breathing rate over 60 breaths per minute.

Conditions that may look like pneumonia include bronchitis, chronic obstructive pulmonary disease, and tuberculosis.

After you've been infected with a pneumonia-causing organism, it takes as little as 1 to 3 days or as long as 7 to 10 days for symptoms to appear. How severe pneumonia is and how long it lasts depend on:

• Your age and health. Older, sicker people usually have more severe cases, and their pneumonia is more likely to have complications, such as bacteria in the bloodstream (bacteremia) or throughout the body (septicemia).
• Whether bacteria or a virus caused the pneumonia. Viral pneumonia usually is less severe than bacterial pneumonia.
• How quickly you treat it. The sooner you treat pneumonia, the sooner symptoms go away.
• Your immune system. People who have impaired immune systems are more likely to have more severe cases of pneumonia than people who have healthy immune systems.

In healthy people, pneumonia can be a mild illness that is hardly noticed and clears up in 2 to 3 weeks. In older adults and in people with other health problems, recovery may take 6 to 8 weeks or longer. If you have severe pneumonia, you may have to go to the hospital.

• In most cases of pneumonia you get in your daily life, such as at school or work (community-based pneumonia), it is not necessary to go to the hospital.¹
• About one-third of people with community-based pneumonia are age 65 or older.¹ Older adults are treated in the hospital more often and stay longer for the condition than younger people.¹ Pneumonia is more serious in this group, because they often have and may develop other medical problems.¹

You are more likely to develop pneumonia if you:

• Smoke. Cigarette smoking is the strongest risk factor for developing pneumonia in healthy young people.²
• Have another medical condition, especially lung diseases such as chronic obstructive pulmonary disease (COPD) or asthma.
• Are younger than 1 year of age or older than 65.
• Have an impaired immune system.
• Have an injury to the rib area, such as a bruised rib.
• Have a change in mental status (such as confusion or loss of consciousness) that increases the risk of breathing mucus or saliva from the nose or mouth, liquids, or food from the stomach into the lungs (aspiration).

You are more likely to have complications of pneumonia and may need to go to the hospital if you:

• Are older than 65.
• Have other illnesses (especially COPD, diabetes, asthma, chronic kidney failure, heart failure, and chronic liver disease).
• Have gone to the hospital for another medical problem within the last 12 months.
• Breathe mucus or stomach contents into your lungs (aspiration).
• Have a changed mental status (such as delirium or dementia).
• Do not have a working spleen (such as in sickle cell disease).
• Have an alcohol use problem.
• Do not get enough healthy foods (malnutrition).

If you are age 60 or older, you are more likely to develop complications if you:³

• Have an alcohol use problem.
• Have a weak immune system.
• Have heart disease.
• Are in an institution, such as a nursing home.

The faster you get treatment, the faster you will get over pneumonia. This is especially true for the very young, for people older than 65, and for anyone with other long-lasting (chronic) health problems, such as asthma.

Call 911 or other emergency services immediately if you:

• Have chest pain that is crushing or squeezing, is increasing in intensity, or occurs with any other symptoms of a heart attack.
• Have trouble breathing that is so severe you are worried you will not have the strength or ability to keep breathing.
• Cough up large amounts of blood.
• Feel that you may faint when you sit up or stand.

Call a doctor immediately if you have:

• A cough that produces blood-tinged or rust-colored mucus from the lungs.
• A fever with shaking chills.
• Difficult, shallow, fast breathing with shortness of breath or wheezing.

Call a doctor if your cough:

• Frequently brings up yellow or green mucus from the lungs and lasts longer than 2 days. Do not confuse mucus from your lungs with mucus running down the back of your throat from your nasal passages (postnasal drip). Postnasal drainage is not a worry.
• Occurs with a fever of 101° (38.3°) or higher and brings up yellow or green mucus from the lungs (not postnasal drainage).
• Causes you to vomit a lot.
• Continues longer than 4 weeks.

Also call your doctor if you have new chest pain (more than just discomfort when you cough) that gets worse with deep breathing and if you have other symptoms of pneumonia, such as shortness of breath, cough, and fever.

Watchful Waiting

Watchful waiting is a wait-and-see approach. If you get better on your own, you won't need treatment. If you get worse, you and your doctor will decide what to do next.

Home treatment may be appropriate if:

• You have classic cold symptoms (nasal stuffiness, mild body aches or headache, mild fever).
• You cough up mucus that is caused by mucus running down the back of the throat from the nasal passages (postnasal drip). However, a cough in which the mucus is definitely coming from the lungs rather than the nasal passages is a more serious problem, and you should contact your doctor.
• You have signs of flu (high fever, severe muscle aches or headache, and mild respiratory symptoms). For more information, see the topic Influenza.

Who To See

Health professionals who can diagnose and treat pneumonia include:

• Family medicine physicians.
• Pediatricians.
• Internists.
• Physician assistants.
• Nurse practitioners.
• Specialists in lung diseases (pulmonologists).

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Your doctor will usually diagnose pneumonia by using your medical history, a physical exam, and a chest X-ray. Based on the medical history and physical exam, your doctor may start your treatment right away without doing other tests. The need for more tests often depends on how severe your symptoms are, your age, and your overall health. In general, the sicker you are, the more tests you will have. This is especially true for older adults and infants.

A chest X-ray is almost always done to check for changes in the lungs that may mean pneumonia and to look for other causes of your symptoms. However, an X-ray does not always show whether you have pneumonia, especially if the X-ray is done when you first get sick.

In some cases, the X-ray results may:

• Suggest the type of organism (bacterial, viral, or fungal) causing pneumonia.
• Show complications of pneumonia.
• Show conditions that may occur with pneumonia, such as fluid in the chest cavity or a collapsed lung.
• Reveal another condition, such as heart failure, lung cancer, or acute bronchitis.

If you are very ill, have severe shortness of breath, or have a condition that increases your risk (such as asthma or chronic obstructive pulmonary disease), your doctor may examine your mucus.

• In a Gram stain, you cough up a sample of mucus (sputum) that is then treated with a material (Gram stain) and examined under a microscope. This test may indicate what type of organism (bacterium or fungus) is causing the pneumonia. This test can help your doctor choose the best medication for your infection.
• In a sputum culture and sensitivity, a sample of mucus is placed in a container with substances that will make bacteria or fungi grow. If bacteria or fungi grow, your doctor can identify them and choose the correct treatment. Unfortunately, getting lung mucus that has not been contaminated with throat or mouth mucus is difficult. Therefore, the results are not always helpful in identifying the cause of pneumonia. This test may be less useful if you have already started using antibiotics.

If you have severe pneumonia, you may need other tests, including tests to check for complications and to determine how well your immune system is working.

A urine test is available that may identify within 15 minutes whether you are infected with Streptococcus pneumoniae, one of the main causes of bacterial pneumonia, or Legionella pneumophila, the bacterium that causes Legionnaires' disease and sometimes can cause pneumonia.

Although experts consider the test to be useful for the identification of Legionella pneumophila, doctors generally do not use it to identify Streptococcus pneumoniae.⁴ However, it may be useful in adults with severe pneumonia and when a Gram stain has not identified the bacteria.⁵

In people with impaired immune systems, pneumonia may be caused by other organisms, including some forms of fungi, such as Pneumocystis jiroveci (formally called Pneumocystis carinii). This fungus frequently causes pneumonia in people who have AIDS. Some doctors may suggest an HIV test if they think that Pneumocystis jiroveci is causing the pneumonia.

Doctors use antibiotics to treat pneumonia caused by bacteria, the most common cause of the condition. You usually will continue to take antibiotics for 5 to 14 days, although you may take them longer if you have an impaired immune system.

Your doctor will choose your antibiotic based on a number of things, including your age, your symptoms and how severe they are, and whether you need to go to the hospital.

Although experts differ on their antibiotic recommendations, the first antibiotic used usually is one that works against a wide range of bacteria (broad-spectrum antibiotic). All antibiotics used have a high cure rate for pneumonia.⁶

If you do not have to go to the hospital, your doctor may use any of the following antibiotics:

• Macrolides, such as Ery-Tab, Biaxin, Biaxin XL, and Zithromax.
• Tetracyclines, such as doxycycline (Vibramycin, Doryx).
• Fluoroquinolones, such as Levaquin and Avelox.

If you have to go to the hospital, your doctor may use any of the above antibiotics. Other antibiotics that your doctor may use in this situation include:

• Cephalosporins, such as Ceclor, Duricef, Ceftin, and Lorabid.
• Penicillins, such as Amoxil, Biomox, Omnipen, Augmentin, Veetids, and Timentin.
• Vancomycin (Vancocin).

Another type of antibiotic, ketolides (telithromycin), was approved for pneumonia in 2004 by the U.S. Food and Drug Administration (FDA). It can be used in mild-to-moderate pneumonia.

Antibiotics usually work well with younger, otherwise healthy people with strong immune systems. You usually see some improvement in symptoms within 2 to 3 days. Unless you get worse during this time, your doctor usually will not change your treatment for at least 3 days. If there is no improvement or if your symptoms get worse, you may need culture and sensitivity testing. These tests help identify the organism that is causing your symptoms and determine whether the bacteria may be resistant to the antibiotic.

You usually will not have to go to the hospital unless you:

• Are older than 65.
• Have other health problems, such as chronic obstructive pulmonary disease, heart failure, asthma, diabetes, long-term (chronic) kidney failure, or chronic liver disease.
• Cannot care for yourself or would not be able to tell anyone if your symptoms got worse.
• Have severe illness with less oxygen getting to the tissues (hypoxia).
• Have chest pain caused by inflammation of the lining of the lung (pleurisy) and therefore are not able to cough up mucus effectively and clear the lungs.
• Are being treated outside a hospital and are not getting better (such as your shortness of breath not improving).
• Are not able to eat or keep food down so that you need to take fluids through a vein (intravenous).

Viral pneumonia

Pneumonia also can be caused by viruses, such as those that cause influenza (flu) and chickenpox (varicella).

• At this time, there is no proven medication to treat pneumonia caused by the influenza virus. Home treatment, such as rest and taking care of your cough, is the only treatment.
• Varicella pneumonia, which is rare, can be treated with the antiviral medication acyclovir.

What To Think About

If you do not need to go to the hospital for pneumonia, it is not usually necessary to identify the organism causing the pneumonia before starting treatment. If you do go to the hospital, you will usually have some additional testing to identify the bacteria.

Getting started early on antibiotics results in better recovery, especially in those age 65 and older who have severe symptoms.⁶

In most cases pneumonia is a short-term, treatable illness. However, frequent bouts of pneumonia can be a serious complication of a long-term (chronic) illness, such as chronic obstructive pulmonary disease (COPD). If you have a severe long-term illness, it may be difficult to treat your pneumonia, or you may choose not to treat it. You and your doctor should discuss this. This discussion may include the possibility of your creating an advance directive. For more information, see the topic Writing an Advance Directive or Care at the End of Life.

There are a number of steps you can take to help prevent getting pneumonia.

• Stop smoking. Smoking makes it more likely you will get pneumonia.
• Avoid contact with people who have respiratory tract infections, such as colds and influenza (flu). Pneumonia may develop after these types of infections.
• If you have not had measles or chickenpox, avoid contact with people who have these infections. Pneumonia can be a complication of measles and chickenpox, so getting these infections can put you at risk for developing pneumonia.

Vaccinations

A vaccine for pneumonia (pneumococcal vaccine) is available. However, research indicates that it might not help everybody.

• Some research shows that the pneumococcal polysaccharide vaccine (PPV) helps prevent pneumonia in healthy younger people but not in older people or those with impaired immune systems.⁶
• Other studies show that the vaccine does not reduce the risk of pneumonia in adults, but it can prevent some of the serious complications of pneumonia, such as infection in the bloodstream (bacteremia) or throughout the body (septicemia), in younger adults and those older than 55 years with a healthy immune system.⁷

Experts recommend the vaccine for people who are older than 65 and for younger people who have a long-lasting (chronic) condition that increases their risk of pneumonia.

Other vaccines can prevent common diseases in which pneumonia may be a complication.

• Vaccination of children for measles can prevent most cases of measles. Adults may need to be vaccinated against measles if they have not had the disease or were not vaccinated during childhood.
• Yearly vaccinations for influenza may prevent you from getting the flu. Influenza often can lead to pneumonia, especially in older adults or in people who have other long-term (chronic) medical diseases. The influenza vaccine can be given at the same time as the pneumococcal vaccine but in a different arm.
• Vaccination with the chickenpox vaccine (varicella-zoster vaccine) can prevent most cases of pneumonia caused by the virus that causes chickenpox. Consider getting a vaccination if you are older than 13 and have not yet had chickenpox.

The mineral zinc may help reduce the risk of pneumonia in children. Zinc can be found in certain foods (lean red meats, seafood, beans, cereals) or added to the diet in supplements. Studies in developing countries found that the incidence of pneumonia in children dropped when zinc was added to the diet.^{8, 9}

The United States recommended dietary allowance (RDA) of zinc for infants is 5 milligrams per day. Children 1 to 4 years old should have 10 milligrams per day.⁸ Always talk to your doctor before giving your child zinc supplements or any other vitamin or mineral supplement.

Home treatment is important for recovery from pneumonia. The following measures can help you recover and avoid complications, such as further infection or a buildup of fluid in the space between the lung and chest wall (pleural effusion ).

While at home:

• Get plenty of rest and prevent dehydration by drinking plenty of fluids.
• Take care of your cough if it is making it difficult for you to rest. A cough is one way your body gets rid of the infection, and you should not try to eliminate coughing unless it is severe enough to make breathing difficult, cause vomiting, or prevent rest.
• Consider taking acetaminophen (such as Tylenol) or aspirin to help reduce fever and make you feel more comfortable. Do not give aspirin to anyone younger than 20 because of the risk of Reye's syndrome.

Always check whether any over-the-counter cough or cold medications you are taking contain acetaminophen. If they do, make sure the acetaminophen you are taking in your cold medicine, plus any other acetaminophen you may be taking, does not exceed the daily recommended dose. Ask your doctor or pharmacist how much you can take every day.

Your doctor may want to see you after a week of treatment to make sure you are getting better. Be sure to contact your doctor if you do not feel better or if you develop a worsening cough, shortness of breath, or a fever; feel weak; or feel faint when you stand up.

Doctors use antibiotics to treat pneumonia caused by bacteria. Your doctor chooses an antibiotic after considering:

• Your age.
• Your symptoms.
• How severe your pneumonia is.
• Other medical problems you might have.
• What type of bacteria may be causing your pneumonia. Most cases of bacterial pneumonia in otherwise healthy people are caused by Streptococcus pneumoniae and Mycoplasma pneumoniae. Several other bacteria may cause pneumonia in the very young, older adults, and those with other diseases.
• Whether you may have a type of bacteria that some medications can no longer kill (resistant bacteria).
• Whether you are allergic to any antibiotics.

Your doctor's choice of antibiotics may also depend on whether you:

• Are otherwise healthy and do not have to go to a hospital for treatment.
• Have other medical conditions but still do not have to go to the hospital.
• Have to go to the hospital.
• Have to go to an intensive care unit.

Medication Choices

Although experts differ on their recommendations, the first antibiotic used is usually one that kills a wide range of bacteria (broad-spectrum antibiotic). All antibiotics used have a high cure rate for pneumonia.⁶

If you do not have to go to the hospital, your doctor may use any of the following antibiotics:

• Macrolides, such as Ery-Tab, Biaxin, Biaxin XL, and Zithromax.
• Tetracyclines, such as doxycycline (Vibramycin, Doryx).
• Fluoroquinolones, such as Levaquin and Avelox.

If you have to go to the hospital, your doctor may use any of the above antibiotics. Other antibiotics that your doctor may use in this situation include:

• Cephalosporins, such as Ceclor, Duricef, Ceftin, and Lorabid.
• Penicillins, such as Amoxil, Biomox, Omnipen, Augmentin, and Veetids.
• Vancomycin (Vancocin).

Another type of antibiotic, ketolides (telithromycin), was approved for pneumonia in 2004 by the U.S. Food and Drug Administration (FDA). It can be used in mild-to-moderate pneumonia.

What To Think About

• In most cases of pneumonia, your doctor will prescribe antibiotics without first identifying the exact organism causing the illness.
• Your doctor may use two antibiotics when first starting your treatment.
• If you do not get better with the first choice of an antibiotic, you may have more testing to identify the specific organism that is causing the pneumonia. Your doctor also may add a second antibiotic to cover other bacteria that are not being treated with the first antibiotic.
• More and more bacteria are developing resistance to certain antibiotics, making them less effective. An example of this is MRSA, or methicillin-resistant staphylococcus aureus, which is resistant to many types of penicillin. To help fight antibiotic resistance, ask your doctor how to take your antibiotics correctly, such as always finishing your prescription.
• Doctors usually treat infants and children with macrolides, penicillin, or (if the child is older than age 8) doxycycline.¹⁰

There is no surgical treatment for pneumonia.

In most cases of pneumonia in young, otherwise healthy people with strong immune systems, treatment can be done at home. Antibiotics, rest, fluids, and home care are all that you need in order to recover. However, people who are having trouble breathing or have other lung problems may need more treatment. In some cases, you may need oxygen or medications you breathe using an inhaler or nebulizer to help shortness of breath and wheezing symptoms.

If pneumonia does not improve with home treatment, symptoms get worse, or signs of complications of pneumonia develop, you may have to go to the hospital. Hospital treatment for pneumonia may include:

• Antibiotics given directly into the bloodstream. A small needle is inserted into a vein (intravenous, or IV) to deliver the medication.
• Fluids given through a vein (IV). They are given if you cannot drink liquids because of shortness of breath or weakness.
• Respiratory therapy, to remove mucus from the lungs. This therapy may include deep breathing exercises, postural drainage, spirometry, and chest physiotherapy, which involves striking the chest with a cupped hand or applying a vibrating device to the chest to loosen mucus. Chest physiotherapy is not necessary in most cases, but it may be helpful for people with other lung conditions, such as bronchiectasis.
• Oxygen therapy. You may need oxygen therapy if your doctor thinks that the cells of your body are not getting enough oxygen. Oxygen can be given through a nasal tube or face mask. For children, oxygen is often given using a tent that fits over the crib.

Organization

• Acute Bronchitis
• Choosing a Health Care Agent
• Hospice Care
• Influenza
• Writing an Advance Directive

Citations

1. Niederman MS (2004). Pneumonia, including community-acquired and nosocomial pneumonia. In JD Crapo et al., eds., Baum's Textbook of Pulmonary Diseases, 7th ed., vol. 1, pp. 424–454. Philadelphia: Lippincott Williams and Wilkins.

2. File TM Jr (2003). Community-acquired pneumonia. Lancet, 362(9400): 1991–2001.

3. Loeb M (2003). Pneumonia in older persons. Clinical Infectious Diseases, 37(10): 1335–1339.

4. Smith MD, et al. (2003). Rapid diagnosis of bacteremic pneumococcal infections in adults by using the binax NOW Streptococcus pneumoniae urinary antigen test: A prospective, controlled clinical evaluation. Journal of Clinical Microbiology, 41(7): 2810–2813.

5. Rosón B, et al. (2004). Contribution of a urinary antigen assay (binax NOW) to the early diagnosis of pneumococcal pneumonia. Clinical Infectious Diseases, 38(2): 222–226.

6. Loeb M (2004). Community-acquired pneumonia. Clinical Evidence (11): 1933–1946.

7. Dear K, et al. (2005). Vaccines for preventing pneumococcal infection in adults. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.

8. Bhutta ZA, et al. (1999). Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: Pooled analysis of randomized controlled trials. Journal of Pediatrics, 135(6): 689–697.

9. Bhandari N, et al. (2002). Effect of routine zinc supplementation on pneumonia in children age 6 months to 3 years: Randomised controlled trial in an urban slum. BMJ, 324(7350): 1358–1362.

10. McIntosh K (2002). Community-acquired pneumonia in children. New England Journal of Medicine, 346(6): 429–437.

Other Works Consulted

• Mandell LA, et al. (2003). Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clinical Infectious Diseases, 37(11): 1405-1433.

Author:	Paul Lehnert	Last Updated May 6, 2005
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Kathleen Romito, MD - Family Medicine Robert L. Cowie, MB, FCP(SA), MD, MSc, MFOM - Pulmonology
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